Smoking Patterns and Receipt of Cessation Services Among Pregnant Women in Argentina and Uruguay

Introduction: The 5A’s (Ask, Advise, Assess, Assist, and Arrange) strategy, a best-practice approach for cessation counseling, has been widely implemented in high-income countries for pregnant women; however, no studies have evaluated implementation in middle-income countries. The study objectives were to assess smoking patterns and receipt of 5A’s among pregnant women in Buenos Aires, Argentina and Montevideo, Uruguay. Methods: Data were collected through administered questionnaires to women at delivery hospitalizations during October 2011–May 2012. Eligible women attended one of 12 maternity hospitals or 21 associated prenatal care clinics. The questionnaire included demographic data, tobacco use/cessation behaviors, and receipt of the 5A’s. Self-reported cessation was verified with saliva cotinine. Results: Overall, of 3400 pregnant women, 32.8% smoked at the beginning of pregnancy; 11.9% quit upon learning they were pregnant or later during pregnancy, and 20.9% smoked throughout pregnancy. Smoking prevalence varied by country with 16.1% and 26.7% who smoked throughout pregnancy in Argentina and Uruguay, respectively. Among pregnant smokers in Argentina, 23.8% reported that a provider asked them about smoking at more than one prenatal care visit; 18.5% were advised to quit; 5.3% were assessed for readiness to quit, 4.7% were provided assistance, and 0.7% reported follow-up was arranged. In Uruguay, those percentages were 36.3%, 27.9%, 5.4%, 5.6%, and 0.2%, respectively. Conclusions: Approximately, one in six pregnant women smoked throughout pregnancy in Buenos Aires and one in four in Montevideo. However, a low percentage of smokers received any cessation assistance in both countries. Healthcare providers are not fully implementing the recommended 5A’s intervention to help pregnant women quit smoking.Fil: Berrueta, Amanda Mabel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Morello, Paola. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Alemán, Alicia. Unidad de Investigación Clínica y Epidemiológica Montevideo; UruguayFil: Tong, Van T.. Centers for Disease Control and Prevention; Estados UnidosFil: Johnson, Carolyn. Tulane School of Public Health and Tropical Medicine; Estados UnidosFil: Dietz, Patricia M.. Centers for Disease Control and Prevention; Estados UnidosFil: Farr, Sherry L.. Centers for Disease Control and Prevention; Estados UnidosFil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Colomar, Mercedes. Unidad de Investigación Clínica y Epidemiológica Montevideo; UruguayFil: Ciganda, Alvaro. Unidad de Investigación Clínica y Epidemiológica Montevideo; UruguayFil: Llambi, Laura. Unidad de Investigación Clínica y Epidemiológica Montevideo; UruguayFil: Becú, Ana. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Smith, Ruben A.. Centers for Disease Control and Prevention; Estados UnidosFil: Buekens, Pierre. Tulane School of Public Health and Tropical Medicine; Estados UnidosFil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Second hand smoke exposure among pregnant women in Argentina and Uruguay

Background Secondhand smoke (SHS) exposure during pregnancy is associated with complications for the pregnant women, the fetus and the newborn that can be very severe. Uruguay and Argentina still have a high prevalence of smoking and national surveys show a high prevalence of SHS exposure in the general population in spite of current legislation. Our objective was to assess SHS exposure among non smoking pregnant women in Argentina and Uruguay. Methods Data were collected from October 2011 to November 2013 as part two-arm parallel cluster randomized trial with baseline and follow-up cross sectional measurements conducted in 10 clusters in Buenos Aires and 10 in Montevideo. During the first 48 hours after delivery, we surveyed pregnant women using a validated questionnaire about tobacco use and SHS exposure at home, at work and indoors in general during pregnancy. Results We surveyed 3039 women in Uruguay and 3799 in Argentina. Overall, 1877 (61.7%) in Uruguay and 2786 (73.3% in Argentina) were non smokers. Among non smoking pregnant women, 37.0% in Argentina and 36.7% in Uruguay had a partner who smoked. Also, 44.4% in Argentina and 47.1% in Uruguay lived with at least one smoker. Overall, 47.7% in Argentina and 48.8% in Uruguay were exposed to secondhand smoke at home (live with at least one smoker/has a partner who smoke and do not have smoke free home rule). Among those who had a job, 13.8% in Argentina and 9.3% in Uruguay were exposed to SHS at work. Conclusions SHS exposure in Argentina and Uruguay is very high during pregnancy, particularly at home. As legislation cannot impose smoke free homes, health care professionals should take advantage of the prenatal care visits to routinely ask about SHS exposure and recommend women to avoid exposure and to implement 100% smoke free homes

Smoking behaviour and second-hand smoke exposure inside vehicles in Uruguay

Background Protection from second-hand smoke (SHS) is one of the fundamental principles of the World Health Organization Framework Convention for Tobacco Control. Scarce data are available on SHS exposure in private areas, such as vehicles. This study aimed to estimate prevalence of smoking inside vehicles and assess the consequent levels of exposure. Methods Levels of fine respirable particles with a diameter of 2.5 micrometres or less (PM 2.5 ) were measured in five experimental models in smokers' and non-smokers' vehicles. Prevalence of smoking in vehicles was estimated in two steps: direct observation of vehicles in different socio economic status areas, and further correction for detectability. Results Median PM 2.5 concentration was 181 µg/m3 in “smoking vehicles” and 0 µg/m3 in “non-smoking vehicles” (p˂0.001). The highest concentration reached 2900 µg/m3 in a parked car with driver's window partially open. We observed 10,011 vehicles. In 219 (2.2%; 95% confidence interval, 1.91-2.49) of them, smoking was observed, and in 29.2% of these, another person was exposed to SHS. According to the multiplying factor we constructed, direct observation detected one of six to nine vehicles in which smoking occurred. The observed prevalence of smoking in vehicles (2.2%) could reflect a real prevalence between 12% and 19%. Conclusions Smoking was found to occur in 12% to 19% of vehicles, with involuntary exposure in one of three. Concentration of particular matter in vehicles reached very high levels, similar to those at certain sites in countries with weak tobacco control policies. These facts underscore a need for new public policies to eliminate SHS in vehicles to protect public health

Brief Counseling on Secondhand Smoke Exposure in Pregnant Women in Argentina and Uruguay

Argentina and Uruguay have a high prevalence of smoking during pregnancy, as well as of secondhand smoke (SHS) exposure. In this secondary analysis of a trial to implement brief smoking cessation counseling during antenatal care in Argentina and Uruguay, we aim to evaluate the effects of the intervention on the rates of self-reported SHS exposure at home and at work, and on attitudes recalled by non-smoker women enrolled in the intervention group compared with the control group. We randomly assigned (1:1) 20 antenatal care clusters in Argentina and Uruguay to receive a multifaceted intervention to implement brief smoking cessation counseling, which also included questions and counseling regarding SHS exposure, or to receive the standard of care. There was not a statistically significant difference between groups of the intervention’s effect (reduction of exposure to SHS) on any of the three exposure outcome measures (exposure at home, work or other indoor areas) or on the attitudes of women regarding exposure (avoiding breathing SHS and having rooms where smoking is forbidden). This analysis shows that we should not expect reductions in SHS exposure with this modest intervention alone. To achieve such reductions, strategies engaging partners and other household members may be more effective